Pelvic organ prolapse in a cohort of women treated for stress urinary incontinence

Am J Obstet Gynecol. 2014 Nov;211(5):550.e1-5. doi: 10.1016/j.ajog.2014.07.053. Epub 2014 Aug 1.

Abstract

Objective: The aim of our study was to observe pelvic organ prolapse (POP) over time, treated and untreated, in a group of highly characterized women being followed up subjectively and objectively over 5-7 years following continence surgery.

Study design: We measured baseline prolapse symptoms and anatomic prolapse in subjects enrolled in the trial of midurethral sling (TOMUS) and E-TOMUS, and measured these same parameters annually for 5-7 years after the index surgery. Additional information about subsequent treatment for POP was also recorded.

Results: In all, 597 women were randomized to 1 of 2 midurethral sling procedures in the TOMUS; concomitant vaginal procedures for POP were allowed at the surgeon's discretion. Stage 2 POP was present at baseline in 291 subjects (49%). Symptoms of POP were reported in 67 (25%). Of the asymptomatic women, 34 of 223 (15%) underwent a concomitant POP repair at the time of index sling surgery. Anatomic progression of prolapse in women with asymptomatic, unoperated stage 2 POP over the next 72 months was infrequent and occurred in only 3 of 189 subjects (2%); none underwent surgery for POP. Most symptomatic women (47/67 [70%]) underwent a concomitant repair for POP at the index sling surgery. Three of the 47 women who had undergone concomitant repair for symptomatic stage 2 POP underwent repeat POP surgery (2 at 36 months and 1 at 48 months.)

Conclusion: For patient populations similar to the TOMUS and E-TOMUS populations, surgeons may counsel women with asymptomatic stage 2 POP that their prolapse is unlikely to require surgery in the next 5-7 years.

Keywords: asymptomatic cystocele; midurethral sling; stress urinary incontinence; urogynecology.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Asymptomatic Diseases
  • Cohort Studies
  • Cystocele / complications
  • Cystocele / physiopathology
  • Cystocele / surgery
  • Disease Progression
  • Female
  • Humans
  • Longitudinal Studies
  • Pelvic Organ Prolapse / complications
  • Pelvic Organ Prolapse / physiopathology*
  • Pelvic Organ Prolapse / surgery
  • Severity of Illness Index
  • Suburethral Slings*
  • Urinary Incontinence, Stress / complications
  • Urinary Incontinence, Stress / surgery*
  • Uterine Prolapse / complications
  • Uterine Prolapse / physiopathology
  • Uterine Prolapse / surgery
  • Vagina / surgery